GAPS BETWEEN

THEORY AND

PRACTICE

Diaron Joehenis

Famanilay, Milette

Ruiz, Kimberly
Introduction

In today’s world, technology play an important role in every industry as well in our personal lives, this particularly

plays a crucial role in the healthcare system. Medical technology is a broad field where innovation provides

sustainable healthcare. With this, practitioners can continue to find ways to improve their knowledge and skills.

Medical education is one thing, it is continuously advancing. One of its goal includes basic knowledge acquisition,

improve decision making, enhance perceptual variation, training for real life critical event, uphold moral and

ethical attributes. Under this education is medical laboratory science (MLS) program which has 2 clear aspects:

clinical and theoretical. These 2 cannot stand alone because you both need it in the lab. Internship program is the

last phase under this course, which is applied in the clinical setting. Initiative introduced through various means

can help close the gap or bridge between theory and practice. Gaps between the two is seen in practioners who

struggles to integrate the knowledge learnt in an academic setting to that of the clinical environment. It is such

importance to reflect on the difference between the two. Theory is a contemplative and rational type of abstract or

generalizing thinking about a phenomenon, or the results of such thinking. The process of contemplative and

rational thinking often is associated with such processes like observational study, research. While practice refers to

A method, procedure, process, or rule used in a particular field or profession; a set of these regarded as standard or

simply the actual application or use of an idea or belief, or method as opposed to theories relating to it.

According to El Hussein & Osuji, 2017), the role of mentors is the best way for interns to make sure their

knowledge is both up to date and relevant their practice. It has been long understood that the best learning comes

through experience and the knowledge they gain from colleagues, but this can be a double edge sword, as

knowledge picked up on the go can be flawed or misinterpreted. This is where mentors play their part in

encouraging reflection and critical thinking to help minimize the gap. One way is sharing their knowledge and

experience. Primary focus should be in supporting academic to clinical collaboration, building research culture
within clinical setting, and improving research access. Researched is informed by practice and vice versa

( Matthew & Tucker, 2018).

According to Archana, et.al., (2018), the use of personal protective equipment (PPE) limits health care workers

contact with all secretions and biological products through physical barriers. On the other hand, blood specimen

collection is a common procedure. One example is venipuncture, which is one of the most frequent procedure done

in the laboratory (Forsman, 1996). Phlebotomy is in line with other practical skills in health care, a complex

procedure thus theoretical knowledge, manual skills, accuracy, and patient care is essential when performing thia

procedure (Bjork & Kirkevold, 2000). It includes process of patient identification, specimen collection, handling,

transport, and reporting of results. (Plebani, et.al., 2011). Some programs aims to evaluate phlebotomy training on

one steps in the procedure like mixing of test tubes, impacts of causing stasis. (Lippi, et.al., 2005, 2011). This is

based on the argument which focuses on one specific problem such as, avoidance of hemolysis, which may be

effective that the address of range procedural problems (Hultdin, et.al., 2013).

This study aims to identify and assess the gaps between theory and practice of MLS students during their internship

program with their contact in clinical setting, that may able to provide them opportunity to close the gap, and be

more familiarize themselves in the clinical aspect.

Methods

This study utilizes a qualitative type research design to identify the gaps between theories and practice under the

MLS internship program. According to Astalin (2013), a qualitative research design is the most flexible of the

various experiment techniques, encompassing a variety of accepted methods, structures, and inform the researched

understanding of social and cultural phenomenon. It includes a combination of observations, interviews, dpcument

reviews, and gives the importance of looking at variables in the natural setting.

In this study, the data were obtained from the experiences of the three MLS interns during their 2 month internship

from their affiliated laboratory “Saint Louis University Sacred Heart Hospital”, dated from January 15-March

12,2020. Due to the unexpected outbreak or COVID-19 pandemic, those 2 months of internship may not be able to
gibe suffice information regarding the gaps between theory and practice from the lack of experience in other

sections. The data were collected through individual observations and interviews. The three MLS interns were

asked of how they experienced the gap between theory and practice, did they do anything about it, how did they

feel on the issue, and how would they like to address the issue. How did they able to cope up with these challenges.

Results and Discussion

The phrase theory-practice is widely used without common definition or description of its underlying concepts

(Greenway, et.al., 2018). The theory-practice gap is nothing new and even though the challenge of bringing

research evidence and clinical practice closer together has been recognised for years, it still remains a problem,

especially for newly qualified staff. The gaps between theory and practice is still evident to clinical practitioners,

especially by the MLS interns. Moving in to a new environment like the clinical setting may be challenging and

stressful to interns, it gives them what reality is inside the laboratory, even more with the gaps between them.

Many underlying factors may be the reason of those gaps.

The three interns observed in their affiliated laboratory the gap just in their first week of internship training. One of

which was the re-using of their own tourniquet. Tourniquet is a material used during phlebotomy in finding the

location of the vein and application limits only up to 2 minutes. According to CLSI standard, tourniquet are

disposed once been used to a patient, and that the repeated use of this may cause nosocomial infections to the

patient. According to them, they just disinfect with it alcohol, or washed it off. Another, experience was during

bleeding tome instead of a sphygmomanometer, the intern only make use of a tourniquet as recommended by the

staff. But in theories, the use of the equipment will have give a quality result and the right amount of pressure

needed during the procedure.

Phlebotomy, which dates back to the age of ancient Greece, has gained experience through the evolution of

medicine becoming a fundamental diagnostic tool. Nowadays it connects the patient with the clinical laboratory

dimension building up a bridge. Although minimal, it is a non-invasive procedure. Thus, piercing could cause pain

or distress to some patients especially children and elderly people. The reduced compliance to venipuncture is also
a major issue to phlebotomist and demands discussion in management. With proper phlebotomy practices reduces

the risk for both the practitioner and patient. The use of proper PPE must be observed and implemented. Most

common PP7E are gloves. It is sterile, and must be one used only. It protects the practitioners from acquiring

infectious materials. Improper used of gloves was observed during their internship. By standards stated in the book,

gloves must be worn only once and be changed after patient encounter. Instead, interns used the gloves more than

once from one patient to another or if not, did not use at all. This kind practice is seen especially when doing

rounds in the wards, where interns tends to more than 1 patient. Meanwhile, another gap seen is the overmixing of

tubes. According to theory, to avoid test error due to additive carryover, a defined order of draw should be

followed for both glass and plastic collection tubes when drawing multiple specimens for clinical laboratory testing

during a single venipuncture. All additive tubes should be filled to their stated volumes. As most tubes contain an

additive or clot activator that needs to be mixed with the blood sample, tubes need to be mixed immediately after

drawing. Tubes with anticoagulants (i.e. EDTA) need to be mixed immediately to ensure that the specimen does

not clot. During phlebotomy, a correct mixing of tubes is done but after going through the section or even during

barcoding. Some interns tend to mix the tube again especially the purple top. This becomes a practice of vigorous

mixing of blood in tubes. Studies have shown that gentle handling of specimen is imperative in in vivo mechanical

trauma of red cells, which can result now to hemolysis or lysis of red cells that can interfere with chemical or

optical analysis.

Conclusion

This paper focused on the long-standing issue of the division between theory and practice in education by

exploring the reasons the gap occurs and persists. Although both studemts and mentors are professionals

in their respective fields, the difference in social perception between them causes the gap. Also, mentor’s

world and cultural orientation is in the opposite continuum of the studemt’s world. In addition, diversity

within each profession allows a wide variation in interpreting teaching practice and research results. In this
study, the gaps between theories and practice is quite evident among the MLS students. Moreover, it shows that

there is lack of understanding and value of the gaps. MLS students faces difficulties and challenges in applying

their knowledge through practice-based theories. Narrowing the gap may be a realistic goal but it seems that it will

always be evident. Bridging the gap between research and the realities of everyday practice is a challenge that isn’t

going away soon nor is it the sole responsibility of academics but a challenge shared by educators and practitioners

too. Further study is recommended.

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